Breaking New Ground

Majid Maqbool

Publish Date: May 7 2018 10:19PM

|

Updated Date: May 7 2018 10:19PM

Meet the doctor from Karnah who is making transformational contributions to the fight against cancer.

A team of researchers led by Prof Ghulam Nabi from Dundee University, United Kingdom, has identified a breakthrough ultrasound technique to accurately diagnose prostate cancer, the second-most frequently diagnosed cancer among men worldwide.

Called Shear Wave Elastography, the technique is non-invasive and less expensive, but offers “much greater accuracy and reliability” than tests currently used to detect prostate cancer. It’s described in the paper “Performance characteristics of transrectal shear wave elastography imaging in the evaluation of clinically localised prostate cancer: a prospective study”, published recently in The Journal of Urology.

“As you can see from the paper which we have recently published, this technique is based on measurement of tissue stiffness and cancers are stiffer than normal tissues,” said Prof Nabi, the clinical head of division of cancer research at the University of Dundee, Scotland. “Shear wave technique also avoids compressing tissue to measure elasticity which used to be a problem with previous elastography methods.”

Prof Nabi, who is originally from Amrohi, a small village near the Line of Control in Kupwara’s Karnah, had been working on this research project for the past five years, leading a group of PhD students and post doctoral researchers.

GOING PLACES

After completing MBBS from Government Medical College, Srinagar, in 1993, Prof Nabi went to New Delhi to pursue MS in General Surgery from AIIMS and later did MCh in Urology. In 2002, he went to Edinburgh, where he was awarded MD in basic and applied sciences research by the University of Dundee in 2006. Four years later, he was appointed consultant urological surgeon at Ninewells Hospital, Dundee. He went on to start the academic urology unit at the University of Dundee the same year.

Prof Nabi is credited with performing the first keyhole surgery for prostate cancer in North Scotland, and the first single port surgery in urological conditions in Scotland. He has done more than 500 laparoscopic radical prostatectomy procedures and is widely published in clinical practice with over 250 publications. “Prostate cancer is one of the most difficult to pinpoint. We are still in a position where our diagnosis of prostate cancer is extremely inefficient, leading to unnecessary treatments for many patients,” he told BBC, adding that the new treatment was “like someone has turned the lights on in a darkened room”. “We have had cases where the SWE technique has picked up cancers which MRI did not reveal. We can now see with much greater accuracy what tissue is cancerous, where it is and what level of treatment it needs.”

Dr Voonna Murali Krishna, surgical oncologist at Mahatma Gandhi Cancer Hospital and Research Institute in Visakhapatnam, said Shear Wave Elastography is an established ultrasound technique that has proved to be useful in identifying early cancers in many solid organs like liver and breast. “It can differentiate between benign tumors and cancers. In the same fashion it may be useful in identifying early cancers of prostate,” Dr Krishna said. “SWE may be useful in suspected cases of early prostate cancers if all other radiological tests are inconclusive.”

Dr Krishna points out that in India prostate cancer is not that common. “And there are no proper screening guidelines or practices in India due to the huge population and lack of resources like finances, technology availability and availability of expertise,” he said, adding that cost benefit ratio is poor in India. “At our institute we use PSMA PET CT for identifying the early cancers of prostate. However SWE is going to be a very promising tool in future.”

Dr N Upendra Kumar, uro-oncologist at Krishna Institute of Medical Sciences in Hyderabad, said because SWE is non-invasive, non-operator dependant and highly reliable in detecting prostate cancer and differentiating from benign lesions, it can help avoid unnecessary biopsies in favour of guided biopsies in positive cases. “In addition, in the present study they have shown reliability in distinguishing carcinoma prostate based on their phenotypes (lower to high grade malignancy) and also the margin status and the local stage of the disease which is unique,” said Dr Kumar.

On the shortcomings of the new study, Dr Kumar said, “It is a single centre study and there was selection bias and ability to detect low grade lesions is not detected in other studies as in this study which requires further confirmation.”

About the assumptions that limit the current applicability of the new technique, he said, “It needs to be standardised and a multi-centre prospective trial needs to be done without any selection bias so that it can be considered as gold standard as histopathology.”

EXCITING NEWS

Prof Nabi said the new technique will change the way prostrate cancer is diagnosed and managed. He pointed out that the current diagnosis of prostate cancer in India and other parts of the world is “not efficient as we land up treating more prostate cancers where treatment may not be needed”, adding that the treatment is costly and has side effects. “With a negative predictive value of 97.8% for the detection of significant cancers in prostate, this technique will help us to avoid unnecessary treatment and perhaps channelise our resources for the few who need urgent treatment.”

Prof Nabi said Shear Wave Elastography has shown good results in other cancers as well. “Results from breast cancer and thyroid are encouraging,” he said, adding that his group is concentrating on methods and techniques to make cost effective ways of detecting cancers using point-of-care diagnostics. With a recent award from Golbal Health Challenge, he said he will also be working with scientists from India on this issue. “We focus on high end ultrasound methods and lasers. And if you can use lasers to sell routine stuff in big stores, why not use these in care of cancers,” he said.

Appreciation for the team of researchers led by Prof Nabi came from British actor Stephen Fry, the former rector of Dundee University who underwent surgery for prostate cancer in January this year. He said the news of the new technique was “doubly, triply exciting”.

“Anyone who has been in my position will know that when it comes to this pernicious disease early screening and diagnosis is the absolute key to a successful outcome,” Fry said. “The news of this breakthrough comes at a time when prostate cancer is being pushed to the forefront of our consciousness in the UK, not least because of the disturbing upward trend in its prevalence. So hurrah for Dundee University and Medical School and a huge thank you to Professor Nabi and his team for their work in developing this new weapon in the war against a deadly killer.”